For Primary Care Providers

Heartburn Program Referral Checklist

If your patients meet one or more of the following criteria, a referral to Northern Light Surgical Specialists may be appropriate. 

  1. GERD that is refractory to medications
  2. GERD medications that are contraindicated
  3. Desire to discontinue GERD medications
  4. Hiatal Hernia and/or GERD who wants to discuss possible surgery
  5. Questions about GERD


If patient has BMI > 40, we recommend they are informed that Surgical Weight Loss may be the appropriate referral for a weight loss surgery as this is also an anti-reflux operation. Both Dr. Sharbaugh and Dr. Toder offer this surgical option.
 
Testing we may use to evaluate the patient referral. Not required prior to referral, however, if already ordered we would like to see results prior to scheduling IOV:

  1. EGD
  2. UGI
  3. Manometry
  4. pH probe
  5. Bravo
  6. CT Abdomen and or Chest
  7. Gastric emptying
 
Instructions for placing a referral for the Heartburn Program:
If you are a Northern Light Health provider:

Order a referral in PowerChart:
  1. Medical Service: General Surgery
  2. Reason for Referral: GERD to Northern Light Surgical Specialists at Eastern Maine Medical Center 
If you are a provider outside of Northern Light Health:
Order a referral by downloading our referral form:

Heartburn Program Referral Form  

Heartburn Program Surgeons:
  • Daniel Hetherman, MD
  • Matthew Sharbaugh, DO
  • Michelle Toder, MD

GERD Handout